PubMed Health⌕ Search

Biomedical subjects

S M Harrigan

Publications and source records attributed to S M Harrigan.

8 recordsLinked to original sources
PubMed2006

Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis.

OBJECTIVE: To evaluate a cannabis-focused intervention (cannabis and psychosis therapy: CAP) for patients continuing to use cannabis following initial treatment for first-episode psychosis (FEP). METHOD: Consecutive admissions to an early psychosis program were screened and consenting individuals using cannabis in the 4 weeks prior to assessment participated. A single-blind randomized controlled trial compared CAP (n = 23) with a clinical control condition (psychoeducation, PE; n = 24). There were no significant differences between the CAP and PE groups on cannabis use at end of treatment and 6 months post-intervention. RESULTS: There were no significant group differences on psychopathology and functional ratings at follow-up. A significant reduction in cannabis use was observed for both groups over time. CONCLUSION: PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort. Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.

Adolescent↗
PubMed2003

Does treatment delay in first-episode psychosis really matter?

BACKGROUND: Relatively few predictors of outcome in first-episode psychosis are potentially malleable and duration of untreated psychosis (DUP) is one. However, the degree to which DUP is mediated by other predictors of outcome is unclear. This study examines the specific effects of DUP on 12-month outcome after adjusting for effects of potential confounders and moderating variables. METHOD: The sample comprised 354 first-episode psychosis patients followed up 12-months after remission/stabilization of their psychotic symptoms. Outcome measures included functional outcome, severity of positive symptoms and negative symptoms. Hierarchical multiple regression assessed whether DUP significantly predicted 12-month outcome after adjusting for other predictors. Contrast analysis further clarified the differential effects of DUP on 12-month outcome. RESULTS: DUP remained a significant predictor of outcome after adjusting for the effects of other variables. This finding remained robust for the subset of patients with schizophrenia or schizophreniform disorder. Functional outcome appeared to decline substantially even after very short treatment delays (> 7 days), with more gradual deterioration in functioning until very long DUP (> 1 year). Good outcome was variably associated with good pre-morbid adjustment, female gender, diagnosis of affective disorder, short duration of prodromal symptoms, and treatment within the Early Psychosis Prevention and Intervention model in contrast to other models of care. CONCLUSIONS: DUP consistently predicts outcome independently of other variables, and is not simply a proxy for other factors. As one of the few potentially malleable factors influencing outcome, DUP could prove to be a target for secondary preventive efforts in early psychosis.

Adolescent↗
PubMed1999

Enduring negative symptoms in first-episode psychosis: comparison of six methods using follow-up data.

Targeted intervention in the early treatment of enduring positive and negative symptoms in first-episode psychosis is contingent on adequate case-identification procedures. Six methods of determining enduring negative symptoms in a sample of 238 individuals with first-episode psychosis who were assessed at three time points over a 12-month period are described. Results were examined at each of the seven combinations of follow-up points, revealing a highly fluid pattern. The percentage of the sample achieving caseness varied dramatically, depending on the method used. Compared with non-cases, the enduring negative symptom group had significantly lower scores on quality of life, poorer premorbid adjustment, and longer durations of prodrome and untreated psychosis. Notwithstanding the 'ebb and flow' of negative symptoms in first-episode psychosis, the results suggest that early identification of enduring negative symptoms is a feasible goal.

Acute Disease↗
PubMed1998

Prolonged recovery in first-episode psychosis.

BACKGROUND: Early identification and specialised treatment of individuals with enduring positive symptoms may assist in alleviating symptoms and has the potential to change the course of illness. METHOD: Prevalence and descriptive data on enduring positive symptoms in two first-episode samples are outlined. Attempts to incorporate the focus of early intervention for persisting psychosis into routine clinical care of individuals with first-episode psychosis are described. RESULTS: Of the 227 individuals with first-episode psychosis who were assessed using the Brief Psychiatric Rating Scale at 3/6 months and 12 months following initial stabilisation (from a total sample of 347), 6.6% experienced enduring positive symptoms at all three time points. When the analysis was restricted to schizophrenia, schizophreniform and schizoaffective disorders (n = 158) the percentage increased to 8.9%. These patients had significantly longer mean duration of untreated psychosis prior to initiation of treatment and, at 12-month follow-up, significantly higher depression and poorer psychosocial functioning. CONCLUSIONS: The association of untreated psychosis with treatment resistance supports the argument for early intervention as soon as possible following the onset of psychotic symptoms.

Adolescent↗
PubMed1998

Group programmes for recovery from early psychosis.

BACKGROUND: We evaluate the impact of a group-based, transitional, psychosocial programme, within a comprehensive service (the Early Psychosis Prevention and Intervention Centre, EPPIC), on recovery from first-episode psychosis. METHOD: Individuals using the service (and meeting study criteria) were assessed on a range of symptom and functioning instruments at entry, after 6 weeks and 6 months. Participants received comprehensive case management and services according to their identified needs. Thirty-four people who had attended the group programme were compared at 6 month follow-up with 61 EPPIC patients who had not attended. RESULTS: The people attending the group programme had a lower level of premorbid adjustment than the comparison group, and a trend towards exhibiting a higher level of negative symptoms, prior to commencing the group programme. However, at 6 month follow-up, no significant differences were found between the groups. CONCLUSIONS: Involvement in the group programme may have had a positive impact on a subgroup of EPPIC subjects with poor level of premorbid adjustment, by providing a 'holding pattern' in the critical period following the emergence of first-onset psychosis, and thus prevented deterioration and the development of disability.

Adult↗
PubMed1996

EPPIC: an evolving system of early detection and optimal management.

Early intervention at the onset of psychotic disorders is a highly attractive theoretical notion that is receiving increasing international interest. In practical terms, it amounts to first deciding when a psychotic disorder can be said to have commenced and then offering potentially effective treatment at the earliest possible point. A second element involves ensuring that this intervention constitutes best practice for this phase of illness and is not merely the translation of standard treatments developed for later stages and the more persistently ill subgroups of the disorder. Furthermore, it means ensuring that this best practice model is actually delivered to patients and families. The relative importance of these elements in relation to outcome has not yet been established. This article outlines a framework for preventive intervention in early psychosis, based on more than a decade of experience initially gained within a first-generation model. This experience has been followed, after a prolonged gestation, by the birth of the Early Psychosis Prevention and Intervention Centre (EPPIC), a comprehensive "real-world" model of care targeting the multiple clinical foci underpinning the preventive task. Data are reported to illustrate the topography and impact of delay in treatment in our regional setting, and the results of an initial evaluation of the EPPIC model are presented. The latter demonstrate a significant improvement in symptomatic and functional outcome when the second-generation model is contrasted with the first. The implications of these findings and future developments are discussed.

Adolescent↗
PubMedDate not supplied

Reduced awareness of illness in first-episode psychosis.

We sought to investigate whether first-episode and multiple-episode patients differ in their awareness of their illness. A total of 312 multiple-episode and 144 first-episode patients participated, the majority of whom had a schizophrenia spectrum disorder (schizophrenia or schizophreniform disorder). Insight was measured using the Scale for the Assessment of Unawareness of Mental Disorder (SUMD). First-episode patients with a schizophrenia spectrum disorder were less aware of having a mental illness than multiple-episode patients. Our findings suggest that in the time following the first episode of psychosis, patients may become less defensive, and possibly more skilled in using medical terms to describe their illness. We suggest a need for skilled psychoeducation that addresses awareness in patients with psychosis, particularly those who are unaware of their illness.

Adult↗